title: Multidisciplinary approach decreases length of stay and reduces cost for ventricular assist device therapy.
abstract: High implantation costs and long postoperative length of stay (LOS) in debilitated patients complicate ventricular assist device (VAD) therapy. Between July 2000 and February 2005, 30 patients received a VAD at our institution. Of those, 20 patients were successfully discharged from the hospital with VADs. In August 2003, a multidisciplinary team was formed consisting of all services for VAD patients to replace a single-discipline (cardiac surgery) system. This team evaluated potential VAD candidates and identified optimal timing for implantation. These 20 VAD patients were divided into two groups according to the initiation of multidisciplinary team; the traditional group (n=7, July 2000-July 2003) and the multidisciplinary group (n=13, August 2003-February 2005). Patient demographics were not different. The LOS decreased from 61 to 15 days (P<0.01), especially LOS on the floor decreased from 35 to 7 days (P=0.03). The floor cost was significantly reduced ($47,111 vs. $8742, P<0.01), leading to a decrease in total postoperative cost ($202,238 vs. $161,744, P<0.01). The 30-day readmission rate decreased (5/7 patients vs. 1/13 patients, P<0.01). A multidisciplinary approach significantly decreased LOS and cost after VAD therapy, mostly by decreasing the cost of routine non-ICU care, without increasing the readmission rate.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Murray
authors.forename: Satoru
authors.initials: S
authors.lastname: Osaki
authors.forename: Niloo M
authors.initials: NM
authors.lastname: Edwards
authors.forename: Maryl R
authors.initials: MR
authors.lastname: Johnson
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Bobadilla
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Gordon
authors.forename: Mark
authors.initials: M
authors.lastname: Sanderfoot
authors.forename: Takushi
authors.initials: T
authors.lastname: Kohmoto
mesh_terms: D000328:Adult; D017046:Cost Savings; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000628:therapy*; D006353:Heart-Assist Devices / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D010359:Patient Readmission / Q000191:economics; D011182:Postoperative Care / Q000191:economics*; D015397:Program Evaluation; D012189:Retrospective Studies; D016896:Treatment Outcome